L-Arginine Rebuttal

A recent article came out condemning l-arginine as causing death after heart attacks. This is the time you need it most of all and my personal experience in my office is that l-arginine has stopped heart attack and stroke so that for my patients, only 0.05% visit the cardiologists for anything at all each year.

This is my rebuttal to the article.

Response to JAMA 1/4/06 Vol 295, No.1, 58-64,
L-arginine therapy in Acute Myocardial Infarction

There are over 40,000 articles which are generally positive on the use of l-arginine to reverse arterial lining (endothelium) elasticity, atherosclerosis, homocysteine and viral damage. How did these authors come to opposite conclusions to these prior studies?

* They started with smaller amounts of l-arginine, 3 gm rather than the 5 grams thought to be the therapeutic amount.
* They reduced the 3 gm to lower amounts if the patients had “side effects” symptoms. They did not state who and how much.
* The source of l-arginine is from a company whose product I do not know.

Patient management had other curious notes.
* Elasticity did not change on treatment. Most research note that this reflects insufficient l-arginine given to the patient.
* Diabetes was “well controlled” – meaningless in the hands of cardiologists unless there are HbA1c etc to prove control.
* Plasma l-arginine changed to less on treatment – how little were they taking? At what times and how often was it decreased in those who died?

This is cardiologists’ research. If treatment does not change elasticity/vascular stiffness like it did for all the references the authors quote shouldn't investigators change the treatment to more l-arginine?
* They quoted 6 articles in the introduction that said l-arginine improved vascular elasticity. Why not follow these articles protocol? This study set out to show endothelial integrity (effect on heart attack) not arterial elasticity.
* Why do a study that didn't achieve the basic starting point and then pronounce l-arginine is dangerous.
* How long did the patients have diabetes? What were other co-morbid states? HbA1c values? What treatments were used for those with diabetes? How well were they controlled during the study? Were the cardiologists attentive to the diabetes care?
* Were the Cardiologists who reviewed this paper aware of the prior science of l-arginine?

There are all sorts of bad science with “significant outcomes” that get published and quoted over the years even though the study design is seriously flawed. Put this publication on the list to join,
* The University Group Diabetes Project – Diabetes – 1970 – don't give all the Orinase in a maximum dose at one time.
* The Effect of Monochromatic Infrared Energy on Sensation in Patients With Diabetic Peripheral Neuropathy Diabetes Care 28:2896-2900, 2005 – don't use subjective measurement of neuropathy when it can be quantitated with FDA approved testing.
* Two New England Journal of Medicine March 16, 2006 stating folic acid and B vitamins a useless to present heart disease – don't recognize that elevated homocysteine is due to an underlying metabolic disorder that needs correction as well as control with folic acid and vitamin Bs.

It’s hard to understand that science does not always agree on any one situation. As doctors, it is up to us to understand the perspective that any science brings and give you the meaning of how to go forward in your life. The people who died all had diabetes. After all, it’s your time.